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Evaluating the Safety of and Adherence to a Vaginal Matrix Ring Containing Dapivirine and Oral Emtricitabine/Tenofovir Disoproxil Fumarate in an Adolescent and Young Adult Female Population

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ClinicalTrials.gov Identifier: NCT03593655
Recruitment Status : Not yet recruiting
First Posted : July 20, 2018
Last Update Posted : January 29, 2019
Sponsor:
Information provided by (Responsible Party):
National Institute of Allergy and Infectious Diseases (NIAID)

Brief Summary:
The purpose of this study is to evaluate the safety of and adherence to a vaginal matrix ring (VR) containing dapivirine and oral emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) in adolescent and young adult females.

Condition or disease Intervention/treatment Phase
HIV Infections Device: Dapivirine vaginal ring Drug: FTC/TDF Phase 2

Detailed Description:

This study will evaluate the safety of and adherence to a vaginal matrix ring (VR) containing dapivirine and oral emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) in adolescent and young adult females.

The study will enroll healthy, HIV-uninfected adolescent and young adult females between 16 and 21 years of age. Participants will be randomized to one of two sequences of one VR containing 25 mg of dapivirine to be inserted monthly for 24 weeks and one 200 mg FTC/300 mg TDF oral tablet taken daily for 24 weeks. After completing the randomized sequence of two study product use periods, participants will then select between the two study products to use in the final 24 weeks of the trial. Participants will be able to choose either or neither study product during the third product use period. The study includes approximately 76 weeks of follow-up per participant.

Participants will attend monthly study visits, which may include behavioral assessments/counseling; physical and pelvic examinations; and blood, urine, and pelvic sample collection.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 300 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: A Phase 2a Crossover Trial Evaluating the Safety of and Adherence to a Vaginal Matrix Ring Containing Dapivirine and Oral Emtricitabine/Tenofovir Disoproxil Fumarate in an Adolescent and Young Adult Female Population
Estimated Study Start Date : January 2019
Estimated Primary Completion Date : June 2021
Estimated Study Completion Date : June 2021

Resource links provided by the National Library of Medicine

MedlinePlus related topics: HIV/AIDS

Arm Intervention/treatment
Experimental: Sequence A: Dapivirine vaginal ring + FTC/TDF
Participants will receive one 25 mg dapivirine vaginal ring inserted vaginally each month for 24 weeks, followed by one FTC/TDF oral tablet taken by mouth daily for 24 weeks, followed by participant's choice of either or neither study product for 24 weeks.
Device: Dapivirine vaginal ring
Vaginal ring containing 25 mg of dapivirine

Drug: FTC/TDF
Tablet containing 200 mg FTC/300 mg TDF
Other Name: Emtricitabine/Tenofovir Disoproxil Fumarate; Truvada

Experimental: Sequence B: FTC/TDF + Dapivirine vaginal ring
Participants will receive one FTC/TDF oral tablet taken by mouth daily for 24 weeks, followed by one 25 mg dapivirine vaginal ring inserted vaginally each month for 24 weeks, followed by participant's choice of either or neither study product for 24 weeks.
Device: Dapivirine vaginal ring
Vaginal ring containing 25 mg of dapivirine

Drug: FTC/TDF
Tablet containing 200 mg FTC/300 mg TDF
Other Name: Emtricitabine/Tenofovir Disoproxil Fumarate; Truvada




Primary Outcome Measures :
  1. Frequency of Grade 2 or higher adverse events (AEs) [ Time Frame: Measured through Week 24 ]
    As defined by the Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events, Corrected Version 2.1, July 2017 and/or Addendum 1 (Female Genital Grading Table for Use in Microbicide Studies [Dated November 2007])

  2. Measurement of detectable drug levels in blood [ Time Frame: Measured through Week 24 ]
    Based on laboratory evaluations

  3. Measurement of residual drug levels in returned VRs [ Time Frame: Measured through Week 24 ]
    Based on laboratory evaluations


Secondary Outcome Measures :
  1. Percentage of participants reporting acceptability of study product [ Time Frame: Measured through Week 24 ]
    Based on participant report

  2. Measurement of detectable drug levels in blood [ Time Frame: Measured through Week 72 ]
    Based on laboratory evaluations

  3. Measurement of residual drug levels in returned VRs [ Time Frame: Measured through Week 72 ]
    Based on laboratory evaluations

  4. Percentage of participants selecting dapivirine VR as compared to FTC/TDF oral tablets [ Time Frame: Measured through Week 72 ]
    Assessed by participant product selection during third product use period

  5. Percentage of participants reporting preference for dapivirine VR as compared to FTC/TDF oral tablets [ Time Frame: Measured through Week 72 ]
    Assessed by participant report of product preference



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Ages Eligible for Study:   16 Years to 21 Years   (Child, Adult)
Sexes Eligible for Study:   Female
Gender Based Eligibility:   Yes
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Age 16 through 21 years (inclusive) at Enrollment, verified per site standard operating procedures (SOPs).
  • Able and willing to provide informed consent, and if under the legal age of consent be able to provide informed assent and obtain parental or guardian permission/consent, to be screened for and to enroll in MTN-034 (as specified in site SOP).
  • Able and willing to provide adequate locator information, as defined in site SOPs.
  • Able and willing to comply with all study procedural requirements.
  • Per participant report at Screening, post-menarche.
  • HIV-uninfected based on testing performed at Screening and Enrollment (per protocol algorithms found in the study protocol).
  • Per participant report at Screening, history of at least one episode of sexual intercourse in participant's lifetime.
  • Negative pregnancy test at Screening and Enrollment.
  • Per participant report, use of an effective method of contraception for at least two months prior to Enrollment, and intending to continue use of an effective method for the duration of study participation; effective methods include:

    • hormonal methods (except contraceptive ring).
    • intrauterine device (IUD).
    • Note: Participant must be on the same contraception method for at least the two months prior to Enrollment.
  • Per participant report at Screening, willing to abstain from inserting anything into the vagina for 72 hours prior to each study visit, including receptive intercourse.

    • Note: In the event the VR has been expelled and requires reinsertion, repositioning the VR is permitted.
    • Note: Participant use of tampons is permitted at any time during the study.
  • At Screening and Enrollment, agrees not to participate in other research studies involving drugs, medical devices, vaginal products, or vaccines for the duration of study participation, unless approved by the Protocol Safety Review Team (PSRT).

Exclusion Criteria:

  • Per participant report at Screening and Enrollment, intends to do any of the following during the study participation period:

    • become pregnant.
    • access and/or use oral PrEP outside the context of study participation.
    • relocate away from the study site.
    • travel away from the study site for a time period that would interfere with product resupply and study participation.
  • At Screening or Enrollment, has a positive HIV test.
  • Diagnosed with urinary tract infection (UTI), pelvic inflammatory disease (PID), sexually transmitted infection (STI) or reproductive tract infection (RTI) requiring treatment per World Health Organization (WHO) guidelines at Screening or Enrollment.

    • Note: Otherwise eligible participants diagnosed during screening with a UTI, PID or STI/RTI requiring treatment per WHO guidelines — other than asymptomatic bacterial vaginosis (BV) and asymptomatic candidiasis — are offered treatment consistent with WHO recommendations. If treatment is completed and symptoms have resolved within 70 days of obtaining informed assent/consent for screening, the participant may be enrolled. Genital warts requiring treatment also must be treated prior to enrollment. Genital warts requiring therapy are defined as those that cause undue burden or discomfort to the participant, including bulky size, unacceptable appearance, or physical discomfort.
  • At Enrollment, has a clinically apparent Grade 2 or higher pelvic exam finding.

    • Note: Cervical friability bleeding associated with speculum insertion and/or specimen collection judged to be within the range of normal according to the clinical judgment of the Investigator of Record (IoR)/designee is considered expected non-menstrual bleeding and is not exclusionary.
    • Note: Otherwise eligible participants with exclusionary pelvic exam findings may be enrolled/randomized after the findings have improved to a non-exclusionary severity grading or resolved. If improvement to a non-exclusionary grade or resolution is documented within 70 days of providing informed assent/consent for screening, the participant may be enrolled.
  • Participant report and/or clinical evidence of any of the following:

    • Known adverse reaction to any of the study products (ever).
    • Known adverse reaction to latex and polyurethane (ever).
    • Symptoms suggestive of acute HIV infection at Screening or Enrollment.
    • Non-therapeutic injection drug use in the 12 months prior to Enrollment.
    • Use of HIV PEP and/or PrEP within the 3 months prior to Enrollment.
    • Currently breastfeeding.
    • Last pregnancy outcome within 8 weeks or less of Enrollment.
    • Participation in any other research study involving drugs, medical devices, vaginal products or vaccines within 60 days of Enrollment.
    • At Enrollment, as determined by the IoR/designee, has any significant uncontrolled active or chronic cardiovascular, renal, liver, hematologic, neurologic, gastrointestinal, psychiatric, endocrine, respiratory, immunologic disorder or infectious disease.
  • Has any of the following laboratory abnormalities at Screening Visit:

    • Positive for hepatitis B surface antigen (HBsAG).
    • Hemoglobin Grade 2 or higher.
    • Calculated creatinine clearance less than 60 mL/min by the Schwartz Equation.

      • Note: Otherwise eligible participants with an exclusionary test may be re-tested during the screening process; re-testing procedure details can be found in the MTN-034 Study Specific Procedures (SSP) Manual. If improvement to a non-exclusionary grade or resolution is documented within 70 days of providing informed assent/consent for screening, the participant may be enrolled.
  • Has any other condition that, in the opinion of the IoR/designee, would preclude informed assent/consent, make study participation unsafe, complicate interpretation of study outcome data, or otherwise interfere with achieving the study objectives.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03593655


Locations
Uganda
MU-JHU Research Collaboration (MUJHU CARE LTD) CRS
Kampala, Uganda
Zimbabwe
Spilhaus CRS Not yet recruiting
Southerton, Harare, Zimbabwe
Contact: Eunice Tahuringana    263-772-882704    etahuringana@uzchs-ctrc.org   
Sponsors and Collaborators
National Institute of Allergy and Infectious Diseases (NIAID)
Investigators
Study Chair: Gonasagrie Nair, MBChB, MPH Emavundleni Research Centre

Responsible Party: National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier: NCT03593655     History of Changes
Other Study ID Numbers: MTN-034
12066 ( Registry Identifier: DAIDS-ES Registry Number )
First Posted: July 20, 2018    Key Record Dates
Last Update Posted: January 29, 2019
Last Verified: January 2019

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:
HIV Infections
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases
Tenofovir
Emtricitabine
Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination
Antiviral Agents
Anti-Infective Agents
Reverse Transcriptase Inhibitors
Nucleic Acid Synthesis Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Anti-Retroviral Agents
Anti-HIV Agents